Overseas recruitment won't solve Australia's aged care worker crisis

Next week’s job summit will need to address the massive staff shortages in aged care. Estimates suggest^[1] 35,000 additional aged care workers per year are needed to fill growing aged care skill shortages. These problems will only increase as demand continues to grow.

Aged care workers provide personal and health care such as showering, feeding and changing dressings, help people with shopping and other community tasks, and support people in their homes and in aged care facilities.

As the recent royal commission into aged care^[2] found, after decades of poor planning and governance, particularly at the local and regional level, it’s now hard to attract workers.

Workers are poorly paid^[3], with hourly wages starting at around A$22. They often work casually or part time and there are limited career pathways.

Only around 5% of providers^[4] are currently exceeding the target staffing levels the new government has promised for 2023. Not surprisingly, there is high staff turnover in the industry and many providers simply can’t get staff.

But while skilled migration can play a role in aged care, it’s unlikely to be enough to fix the immediate or long-term problems.

Read more: 'Fixing the aged care crisis' won't be easy, with just 5% of nursing homes above next year's mandatory staffing targets^[5]

What has the government done to boost workers so far?

The new federal government has opened up the Pacific Australia Labour Mobility (PALM) scheme^[6] to bring in more aged care workers to plug the gap.

The PALM scheme allows eligible aged care providers to hire workers from nine Pacific islands and Timor-Leste for between one and four years in unskilled, low skilled and semi skilled positions when there are not enough local workers available.

Currently, there are about 27,000 PALM workers^[7]in Australia. Most are in agriculture and manufacturing. The federal government is committed to growing the scheme, but at the end of 2021 there were only about 150 PALM workers in the care sector.

Migration processing is lagging

The total migration program is 160,000 visas per year^[8]. About 110,000 visas are for skilled migration. The rest is for families. The federal government has recently indicated^[9] it is looking at permanent migration for aged care workers.

Following COVID, there is a massive backlog^[10] in processing applications, resulting in a substantial reduction in migration^[11].

The Department of Foreign Affairs and Trade handles skilled visa applications and the actual assessments are issued by one of 42 skills assessing authorities^[12]. A full skills assessment takes about four to six weeks. But it takes around six to nine months^[13] for the department to issue skills visas for permanent migration and longer for temporary migration.

The Department of Home Affairs has been directed to speed up visa processing^[14] and clear the substantial backlog that has built up during the last three years.

But migration numbers are unlikely to meet demand

Even if the backlog is addressed and processing times improve, it is unlikely there will be sufficient appropriately qualified applicants to meet the aged care shortages through skilled migration, given the high demand^[15] for workers across the board and the international shortage of health care workers.

There are also broader risks in relying on temporary migration to fix short-term problems. Temporary solutions have a nasty habit^[16] of becoming permanent and undermining labour market conditions. There is now a long history^[17] of temporary migration undercutting wages and workers’ rights.

Read more: Australia is missing 500,000 migrants, but we don't need visa changes to lure them back^[18]

So what can be done to attract and keep aged care workers?

5 ways to boost the aged care workforce

1. Increase wages

Most importantly, wages for aged care workers must be improved immediately. The current work value case^[19] before the Fair Work Commission will help if the commission grants a substantial wage increase. The unions have called for a 25% lift to wages for aged care workers. That case should be determined later this year.

2. Improve conditions

Better wages alone won’t be enough. Conditions for aged care workers have to be made more secure. While consumer choice and flexibility are important, that can’t be at the expense of proper protections for workers. Aged care workers often have^[20] insecure and variable hours, split shifts and out-of-pocket costs.

3. Scale up training

Training and career structures have to be much more attractive. Around 30% of the workforce do not hold a relevant aged care qualification^[21].

Despite the demand for improved training, the vocational education sector has difficulty attracting aged care students. Entry pathways to aged care work have to be made much more attractive.

While there are some traineeships for aged care, these could be scaled up. A national scaled up program of paid aged care traineeships should be considered to address the problem as an immediate extension of the federal government’s free TAFE initiative.

A Certificate III in Individual Support^[22] could be completed over two years with trainees working three days a week with approved home care and residential care providers. Training and supervision could be provided in partnership with TAFEs.

Paid traineeships would be attractive – and 10,000 to 15,000 traineeships would make a significant dent in the aged care workforce shortage.

The costs of aged care employment and training are already included in federal and state aged care and VET budgets. A traineeship scheme could be implemented in 2023.

Read more: Budget gives $49.5 million for aged care training, but what about wages?^[23]

4. Develop career structures so workers can progress

In the medium term, aged care career structures have to be reformed both to improve the quality of the management, supervision and care of aged care services and to develop and retain the aged care workforce.

The new government’s initiatives^[24] to require 24/7 nursing oversight in all residential care facilities and to increase the care time to be provided are a start, but a broader emphasis on restructuring the personal care workforce is also needed. In particular, all personal care staff should be required to have appropriate training and registration to work in aged care.

5. Make it more attractive

Finally, the attractiveness of working in a reformed aged care sector needs to be promoted. A compelling vision of a high quality, well run, properly funded aged care sector with good wages and conditions and career pathways is needed to make aged care a much more desirable career choice.

References

1. ^{^} Estimates suggest (www.ceda.com.au)
2. ^{^} royal commission into aged care (agedcare.royalcommission.gov.au)
3. ^{^} poorly paid (theconversation.com)
4. ^{^} around 5% of providers (theconversation.com)
5. ^{^} 'Fixing the aged care crisis' won't be easy, with just 5% of nursing homes above next year's mandatory staffing targets (theconversation.com)
6. ^{^} Pacific Australia Labour Mobility (PALM) scheme (www.abc.net.au)
7. ^{^} 27,000 PALM workers (www.palmscheme.gov.au)
8. ^{^} 160,000 visas per year (www.y-axis.com)
9. ^{^} has recently indicated (www.smh.com.au)
10. ^{^} massive backlog (www.sbs.com.au)
11. ^{^} substantial reduction in migration (theconversation.com)
12. ^{^} 42 skills assessing authorities (immi.homeaffairs.gov.au)
13. ^{^} around six to nine months (ahwc.com.au)
14. ^{^} directed to speed up visa processing (minister.homeaffairs.gov.au)
15. ^{^} high demand (www.nytimes.com)
16. ^{^} nasty habit (theconversation.com)
17. ^{^} long history (onlinelibrary.wiley.com)
18. ^{^} Australia is missing 500,000 migrants, but we don't need visa changes to lure them back (theconversation.com)
19. ^{^} work value case (www.fwc.gov.au)
20. ^{^} Aged care workers often have (theconversation.com)
21. ^{^} 30% of the workforce do not hold a relevant aged care qualification (onlinelibrary.wiley.com)
22. ^{^} Certificate III in Individual Support (www.tafecourses.com.au)
23. ^{^} Budget gives $49.5 million for aged care training, but what about wages? (theconversation.com)
24. ^{^} initiatives (www.alp.org.au)